AAAAI: Many Kids Shake Milk Allergy As Toddlers

Action Points

Note that these studies were published as abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Explain that these studies of more than 200 children allergic to cow's milk found that more than one-third outgrew their food allergy before age four.

Point out that lower initial reactivity to cow's milk on skin testing and by serum immunoglobulin E (IgE) levels predicted which infants would lose their allergy over time.

SAN FRANCISCO -- More than one-third of babies allergic to cow's milk will outgrow their food allergy before age four, researchers found in a multicenter observational study.

The study found that milk allergy resolved for 36.9% of the 244 infants followed to about age 3.5 years, Robert A. Wood, MD, of Johns Hopkins, and colleagues reported here at the American Academy of Allergy, Asthma & Immunology meeting.

Lower initial reactivity to cow's milk on skin testing and by serum immunoglobulin E (IgE) levels predicted which infants would lose the allergy over time in the NIH-funded Consortium of Food Allergy Research (CoFAR) study.

But a second report presented here, from some of the same research group, indicated that changes in the severity of atopic dermatitis didn't correlate with loss of allergy to milk, as often believed.

While parents may find reassurance in the substantial likelihood of their child outgrowing milk allergy -- the most common food allergy in the Western world -- Wood noted that these findings may not only help predict the course of the allergy itself, but may also be practical for clinical use.

The strategy of building up tolerance through progressive doses of the allergy-causing food is still considered investigational, but it's widely expected to become a common part of clinical practice over the next five or ten years, coauthor A. Wesley Burks, MD, of Duke University Medical Center in Durham, N.C., commented at a press conference.

For those children whose milk allergy resolves on its own without treatment, prior studies -- typically smaller and single-center in design -- have provided a widely varying picture of the time course that can be expected, Wood noted.

So his group looked at the natural history of milk allergy using a multi-center CoFAR cohort of children enrolled at age 3 to 15 months with a convincing history of food allergy or moderate to severe atopic dermatitis or both along with a positive skin prick test.

Among the 244 milk-allergic children followed for 30 months in the study, the average age at which their allergy seemed to resolve was 24 months -- confirmed by successfully ingesting uncooked milk without a reaction.

The 89 toddlers who became tolerant had lower baseline levels of milk IgE than those who remained allergic to milk (median 0.72 versus 6.99 kUA/L, P<0.001).

The likelihood of resolution varied dramatically from a rate of 64% among those with IgE levels under 2 kUA/L to just 7% among those with a level of 10 kUA/L or higher.

Kids who lost their allergy to milk also developed smaller skin wheals where exposed to milk on a skin prick test, compared with those who didn't outgrow the allergy (median 5.0 versus 9.25 mm, P<0.001).

But the other CoFAR analysis led by Amy M. Scurlock, MD, of Arkansas Children's Hospital in Little Rock, showed that a reduction in severity of atopic dermatitis didn't portend a resolution in food allergy.

That analysis included 62 milk-allergic babies in the same cohort with initially moderate-to-severe atopic dermatitis that became mild or disappeared by two years of follow-up. Milk allergy resolved during follow-up for 19% of these children compared with 32% of 66 whose dermatitis did not improve (P=0.11).

The 25 egg-allergic kids whose atopic dermatitis decreased over two years of follow-up likewise weren't more likely to see resolution of their food allergy than those whose dermatitis remained moderate to severe (28% versus 22%, P=NS).

Resolution of food allergy in the observational CoFAR cohort was not determined by a protocolized challenge -- which Wood cautioned may have skewed the results toward a lesser degree of allergy resolution.

About half of the resolved milk allergy cases were determined by a formal food challenge spurred by clinical considerations, and the other half were resolved by at-home introduction of milk with no demonstrated reaction.

Wood noted that the CoFAR cohort will be followed to age 10 in 2015.

The CoFAR study was supported by the NIH/National Institute of Allergy and Infectious Diseases.

Wood reported advisory board and grant relationships with the Food Allergy and Anaphylaxis Network and the NIH.

Scurlock reported financial relationships with the University of Arkansas for Medical Sciences/Arkansas Children's Hospital, NIH/NIAID, and Genocea Biosciences.

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